Performance data

CAMHS produce Safety, Quality, Performance and Patient Experience and Patient Outcomes Reports for each of their teams. The purpose of these reports is to provide a succinct ‘snapshot’ of each CAMHS service by bringing together information from a broad range of areas including:

Catchment statistic and maps

Staffing

Capacity and demand modelling

Integration and shared care arrangements

Budget and activity data

Education and training

Quality improvement and audits

Clinical incidents and risk

Consumer feedback and patient outcomes.

The reports also help inform our stakeholders about what CAMHS services can and cannot provide.

Seclusion and Restraint Performance data

Seclusion and restraint interventions occur as a last resort. Staff will always attempt to de-escalate a situation in less restrictive ways before restraining or secluding a young person. They are safety interventions, and will never be used as a substitute for less restrictive treatment efforts, punishment or for the convenience of staff, and are only ever used to prevent young people from harming themselves or others.

When seclusion or restraint does occur it will last for the shortest time possible, and the incident will be reviewed with the young person afterwards with the purpose of understanding why the incident occurred and developing alternatives to the crisis occurring in the future.

Staff are trained in Therapeutic Crisis Intervention, which aims to de-escalate a situation before seclusion or restraint is necessary. If failing to de-escalate the situation and seclusion or restraint is necessary, staff will do so with safety and dignity.

Seclusion and restraint data is recorded and measured against national benchmarks and all incidents are reviewed to ensure we are continuously attempting to reduce the occasions of seclusion and restraint.

Seclusion events per 1,000 bed days

Understanding mental health seclusion events

Seclusion is defined as the confinement of a patient at any time of the day or night alone in a room or area from which free exit is prevented. The purpose, duration, structure of the area and awareness of the patient are not relevant in determining what is or is not seclusion.

Seclusion also applies if the patient agrees to or requests confinement and cannot leave of their own accord. However, if voluntary isolation or ‘quiet time’ alone is requested and the patient is free to leave at any time then this social isolation or 'time out' is not considered seclusion.

Child and Adolescent Mental Health Service seclusion events per 1,000 bed days

Quarterly Data, 01 July 2016 – 30 September 2017

Table 1: CAHS-CAMHS Seclusions per 1,000 bed days

Quarter

CAHS-CAMHS
Bed days

Seclusions
(inc. with restraint)

Number of
patients with seclusion
events

CAHS-CAMHS seclusion
events per 1,000 bed days

Jul-Sept 2016

809

17

8

21.0

Oct-Dec 2016

786

29

8

36.9

Jan-Mar 2017

925

23

5

24.9

Apr-Jun 2017

1326

4

2

3.0

Jul-Sept 2017

1400

12

5

8.6

Restraint events per 1,000 bed days

Understanding mental health restraint events

During a day or part of a day that a patient is admitted to receive hospital treatment, and under certain circumstances, patients may require restraint due to an immediate or imminent risk to their or others health or safety. The decision to use seclusion is a clinical one, to be taken after other less restrictive options have been considered, tried or excluded. The time of a seclusion event varies, dependent on the clinical need.

Where clinically appropriate CAMHS may use physical restraint, which is the application by health care staff of 'hands-on' immobilisation or the physical restriction of a person to prevent the person from harming himself/herself or endangering others or to ensure the provision of essential medical treatment. CAMHS does not use mechanical restraint.

Established an accountability of restraint and seclusion practices through formal and consistent benchmarking and evaluation

Integrated consumer experiences of seclusion and restraint into clinical education and policy development.

SafeWards model introduction

The SafeWards model has been introduced at the CAMHS Inpatient Unit. SafeWards is an international clinical model designed to make inpatient wards safer and more therapeutic. International evidence indicated that this model significantly reduces the occurrences of seclusions and restraints, and CAMHS data on the reduction of seclusion and restraints since implementing SafeWards supports this.

Executive reviews of seclusion

Each time the seclusion room is used, an executive review of the seclusion is implemented. This provides a mechanism to review, assess and reduce future seclusions.

The opening of low-acuity, non-authorised beds at the CAMHS Inpatient Unit

When the CAMHS Inpatient Unit was refurbished, low-acuity, non-authorised beds were opened. A number of least restrictive factors were taken into consideration, including:

the inclusion of comfort and sensory modulation rooms to promote self- regulation and reduce escalation

improved access to outdoor areas

enhanced group programs

development of care packages to promote voluntary access to the inpatient unit prior to crisis in a planned way

allowing young people and families a greater choice regarding admission.

These changes have also been made to the existing wing of the inpatient unit.

CAMHS agree with the United Nation’s Principles for the protection of persons with mental illness and the improvement of mental health care:

"Physical restraint or involuntary seclusion of a patient shall not be employed except in accordance with the officially approved procedures of the mental health facility and only when it is the only means available to prevent immediate or imminent harm to the patient or others More information on seclusion and restraint."